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What is ovarian cancer?

Ovarian cancer is cancer in one or both ovaries. Ovaries are small organs located on each side of a women’s pelvis. They produce sex hormones, regulate the menstrual cycle, and produce eggs. While ovarian cancer isn’t common, women of any age can get it. It is serious and, if it progresses too far, it can be fatal.

Symptoms of ovarian cancer

Most women don’t have symptoms of ovarian cancer until cancer has spread outside the ovary. Plus, symptoms are similar to other medical conditions, not just ovarian cancer. When they do occur, symptoms include:

• Menstrual changes (unusual bleeding or discharge)
• Bloating or swollen stomach
• Diarrhea, constipation, or frequent urination
• Stomach, back, or pelvic pain
• Lump in the pelvic area
• Loss of appetite or quickly feeling full
• Nausea
• Digestion problems

Because these symptoms can have many causes, ovarian cancer may be hard to diagnose early. That’s why it’s good to know your body. Be aware of slight changes and share them with your doctor. Also, talk with your doctor if your symptoms persist or worsen.

What causes ovarian cancer?

Family history is one of the biggest risk factors for ovarian cancer. The breast cancer genes, BRCA1 and BRCA2, are hereditary. If you have these genes, and if they change inside your body, they can cause ovarian cancer. The American Academy of Family Physicians (AAFP) recommends genetic counselling and testing for women with this family history. Talk to your doctor if you think you meet the screening requirements.

There are other risk factors for ovarian cancer. These include your pregnancy and reproductive history, use of hormone replacement therapy, poor diet, and inactivity. But being at high risk for ovarian cancer doesn’t mean you’ll get it. Your doctor can perform tests to examine potential signs. These tests include a pelvic and vaginal exam, X-ray, ultrasound, or blood test.

Cancer from other areas in your body, such as your breasts or colon, can also lead to ovarian cancer.

How is ovarian cancer diagnosed?

Your doctor will talk with you about your medical history, your family’s medical history, and your symptoms. They will do a pelvic exam to feel for issues with your ovaries.

Your doctor also may order a pelvic ultrasound. This is a painless procedure that will take pictures of the inside of your body. Your doctor also may ask you to have a biopsy. This is when a piece of the mass in your ovary is removed and sent to a lab to examine under a microscope. A biopsy is the only way to confirm ovarian cancer.

The AAFP does not recommend ovarian cancer screening. Screening is used to identify conditions prior to having any symptoms. AAFP has found that ovarian cancer screening is not accurate or valuable. AAFP also recommends against genetic counselling related to ovarian cancer, unless you are at high risk.

Can ovarian cancer be prevented or avoided?

Ovarian cancer can’t be prevented or avoided. However, certain risk factors increase your chances of getting it. These include:

• BRCA1 or BRCA2 genes
• Family history of ovarian cancer
• Personal history of breast, cervical, colon, or melanoma cancer
• Having a personal history of Lynch syndrome (a medical condition)

• Endometriosis (a medical condition that causes tissue to grow outside your uterus)
• Infertility or being pregnant later in life
• Being of Ashkenazi Jewish descent (Eastern European)
• Taking hormone replacement therapy for 5 years or more

Talk to your doctor about screening or testing if you have any of these. If you’re extremely high-risk, your doctor might recommend removing your ovaries. This surgery is called an oophorectomy.

Any woman can develop ovarian cancer. Studies show that some things can reduce your risk, such as:

• Giving birth
• Breastfeeding for 1 or more years
• Using (or previous use of) birth control pills
• Removing ovaries, having tubes (fallopian) tied, or having a hysterectomy (surgery to remove all or part of the uterus)

Ovarian cancer treatment

Treatment requires a team of specialists. Your doctor will refer you to a specialist called an oncologist. This doctor specializes in cancer treatment. You also may be referred to a surgeon. They may be able to remove your cancer.

Both the oncologist and the surgeon will discuss treatment with you. After meeting with them, you may want to seek a “second opinion” from another oncologist and/or surgeon.

Treatments vary based on the type, grade, and stage of cancer.

Type

There are many types of ovarian cancer that fall into the main categories.

• Epithelial tumor. This is the most common, and most dangerous, type of ovarian cancer. It forms in the tissue that covers your ovary.
• Germ cell tumor. This develops in the cells that create your eggs each month. This type of ovarian cancer is most common in teens and women younger than 30 years old.
• Stromal tumor. This develops in the tissues that produce the female hormones estrogen and progesterone. This type of cancer is rare.
• Primary peritoneal cancer is one of the less common types. This cancer starts in the peritoneum. That is the tissue that lines your stomach and covers your female organs.

Grade

Grades rate how the cancer cells look compared to healthy cells. If there’s not much difference, the tumor is a low-grade tumor. If there’s a lot of difference, the tumor is a high-grade tumor. Grades can help your doctor determine how cancer may act in the future.

Stage

Stages rate if the cancer is contained to the ovary or if it has spread. Your surgeon will be able to help determine the staging during surgery to remove the tumor. Your doctor also may order additional tests to see if cancer has spread to other areas of your body. This is usually done with imaging, such as an X-ray, colonoscopy, CT (computed tomography) scan, MRI (magnetic resonance imaging), or PET (positron emission tomography). There are four stages of cancer. Stage 4 is the most severe.

The goal of cancer treatment is:

• Remove or get rid of cancer
• Keep cancer from spreading
• To reduce side effects and pain related to cancer

Most treatment programs include a mix of:

• Surgery to remove the cancerous cells and tissue. It also may include the removal of the affected and surrounding organs.
• Chemotherapy to reduce or kill cancer. Chemo medicine can be given in pill, liquid, or IV (intravenous) form. Also, it can be injected directly into the affected area.
• Radiation to reduce or kill cancer using high-energy waves, similar to X-rays.

Living with ovarian cancer

Treatment is more successful if the cancer is detected early. Also, your outcome depends on your general health, and the type, grade, and stage of cancer.

Your doctor will monitor your treatment. They will check to see if the cancer is gone. Your doctor also might perform regular tests to detect its return. You might have lasting side effects from the cancer treatment. Your doctor will work with you to reduce those.

Questions for your doctor

• What are the type, grade, and stage of my cancer?
• What outcome can I expect based on the type, grade, and stage of my cancer?
• Has my cancer spread?
• What treatment is best for me?
• What are the side effects of treatment?
• What are the chances my cancer will come back?
• Are there any clinical trials for my type of cancer?
• Will ovarian cancer affect my ability to get pregnant?
• If I have ovarian cancer, can my close relatives get it?

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